Alcohol — The Good Side

Stanton Peele

As California contemplates legalizing the sale of marijuana, the real war over intoxicants in this country is, as always, over alcohol.

Since Prohibition ended in 1933 with the 21st Amendment to the Constitution — which repealed the 18th Amendment authorizing the ban on alcohol — states, counties and municipalities have see-sawed back and forth over alcohol sales. States are still passing laws on the sale of alcohol on Sundays, and municipalities and counties are still voting on whether to permit local alcohol purchases.

But as an addiction psychologist and alcohol epidemiologist, I am more interested in another debate over alcohol: whether it can be good for you. This issue arises every five years as the United States issues new dietary guidelines, including for alcohol consumption. In 1990, the Dietary Guidelines for Americans firmly declared that alcohol "has no net health benefit, is linked with many health problems, is the cause of many accidents and can lead to addiction. Their consumption is not recommended."

But in 1995, based on the results of studies identifying subjects who drank and did not drink and then following their health outcomes over time, the guidelines modestly declared — amid a sea of information about the dangers of drinking — that "alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history" and that "current evidence suggests that moderate drinking…is associated with a lower risk for coronary heart disease in some individuals."

A firestorm resulted over these words, led by the late Sen. Strom Thurmond (R-S.C.), a notorious teetotaler. Somehow, the section came through intact, to the amazement of a member of the committee writing the guidelines, Marion Nestle, then-chairwoman of the Department of Nutrition, Food Studies and Public Health at New York University. "It's a miracle, a miracle," she told the New York Times. "It is a triumph of science and reason over politics. The committee process was very contentious, but the outcome makes the fuss seem worthwhile."

Well, the same forces are back doing battle for the 2010 edition of the guidelines. In the intervening years, quite a bit of evidence has accumulated to take the statement of alcohol's benefits even further. The 2010 guidelines' alcohol section group is headed by epidemiologist Eric Rimm of Harvard Medical School, where he is a co-director of the Health Professionals Follow-Up Study that has tracked doctors' and nurses' health outcomes and drinking for decades. But the opposition this time around is not teetotaler Southern politicians.

According to the experts charged with creating the alcohol section, strong evidence indicates that "the lowest mortality risk for men and women [occurs] at the average level of one to two drinks per day, [and] is likely due to the protective effects of moderate alcohol consumption on CHD [coronary heart disease], diabetes and ischemic stroke as summarized in this chapter."

In other words, people who have a couple of drinks daily live the longest! Adding what for some is insult to injury, the group also noted: "Moderate evidence suggests that compared to non-drinkers, individuals who drink moderately have a slower cognitive decline with age." Moderate drinkers not only live longer, they are more alert while doing so!

Despite these proposed additions to the guidelines, the overwhelming burden of the alcohol section is to portray the negative health, psychological and addictive effects of alcohol. But this has not been enough to avoid a sharp blowback from medical, public health and addiction professionals, who have started a campaign to limit these recommendations out of a fear their impact "would likely be to encourage greater daily consumption of alcohol, discourage appropriate caution about using alcohol for health benefits, and open the door for the alcohol industry to misrepresent federal alcohol consumption guidelines to consumers."

And so it goes — the war over alcohol in America continues ad infinitum.